Until the very end, she used every tool she had to fight against trade rules that protect drug company monopolies and deny patients essential medicines.
Eight years ago, in our book The Spirit Level: Why More Equal Societies Almost Always Do Better, we shared with readers the correlations between higher inequality and higher rates of mental illness. Since then, other pieces of the inequality-and-mental-health jigsaw puzzle have been falling into place — and quite rapidly.
A path-breaking paper by Sheri Johnson and her colleagues, for instance, shows that a number of mental illnesses and personality disorders at least partly reflect responses to issues of social dominance and subordination, involving the brain’s “dominance behavioural system.”
Externalizing disorders, mania proneness, and narcissistic traits seem to be related to heightened dominance motivation and inflated self-perceptions of power. In contrast, the research relates anxiety and depression to subordination and submissiveness, as well as a desire to avoid subordination.
During her research Johnson seems to have regarded social status hierarchies as if they did not differ much from one society to another. But other research papers now suggest that depression, schizophrenia, narcissism, and psychotic symptoms all more commonly appear in more unequal societies. The implication: Greater inequality makes issues of dominance and subordination a more important part of the social reality we confront.
Bigger income differences make the rich seem ever more important, as almost superior beings. The poor, meanwhile, come to be regarded as almost worthless. This tendency to take people’s external wealth as an indication of their internal worth becomes stronger as inequality mounts. We all worry more about how others see us and judge us. Our status matters more and more. To use the psychological jargon, the “social evaluation threat” increases.
In more unequal societies, the data indicate, status anxiety increases not just among the poor, but across all income deciles. We all worry more about whether others see us as capable and successful — or as a failure.
At the same time, the research on how hormone levels react to different kinds of stress has shown that threats to self-esteem and social status — situations, for example, where you fear being judged negatively — turn out to be particularly strong sources of stress. Stress hormones respond significantly to social evaluation anxieties.
Inequality also damages mental health in a variety of other ways. A number of studies now show that people in more unequal societies are much less likely to feel they can trust each other. Within rich developed societies, the proportion of the population who agree that “most people can be trusted” falls from 60 or 65 percent in the most equal nations to around 20 percent in the most unequal. These differences can make a considerable difference to whether we feel safe walking home alone at night.
Studies also show that participation in community life atrophies in more unequal societies. People are less likely to belong to voluntary groups and associations or to participate in local activities. At the same time, violence — usually measured by homicide rates — increases in more unequal societies, and people become less willing to help each other.
Why do people have less to do with each other in societies with wider gaps in income and wealth? One key reason: Increased “social evaluative” threats make social life more stressful. Social anxiety increases in more unequal nations, and we worry more about how we appear and how we perform socially.
Some respond to these “social evaluative” threats with defensive narcissism. Others show low self-esteem and a lack of confidence. Still others experience social life almost as an ordeal to be avoided whenever possible.
The last part of this mental health picture may be how inequality feeds into consumerism. Raised social anxiety and narcissism boost consumerism. We use purchases and possessions to give a good impression and create a sense of self-worth. Money becomes more important as the means through which we communicate our self-worth.
People in more unequal societies, the data show, don’t just work longer hours. They also save less and borrow more. Debt rises with inequality as we try to keep up appearances. Recent research confirms that inequality particularly boosts the consumption of status goods. As advertisers know, status anxiety sells.
And sadness spreads — as inequality undermines our mental health and the friendships, positive social relations, and active community life so essential to our wellbeing. Inequality, in sum, strikes at the very heart of what a good society should be.
Richard Wilkinson, an emeritus professor of public health at the University of Nottingham, and Kate Pickett, a University of York epidemiologist, are the co-authors of the worldwide bestseller, The Spirit Level: Why More Equal Societies Almost Always Do Better.
Richard Wilkinson explains what gets worse when rich and poor grow too far apart.